18 March 2019

Study loosens links between secukinumab and IBD

Clinical Rheumatology

Patients can now have some reassurance the drug secukinumab, prescribed for psoriasis, psoriatic arthritis and ankylosing spondylitis, generally does not cause inflammatory bowel disease.

The observational study, sponsored by Novartis Pharma AG and published in the BMJ in March, showed less than 1% of patients on the drug developed symptoms of inflammatory bowel disease (IBD).

The study pooled data from over 7,000 patients across 21 RCTs.

Within the group of patients on secukinumab in the clinical trial, there were only 41 cases of active IBD reported, and of these, 30 were new onset cases.

Patients with psoriatic conditions already had a greater prevalence of inflammatory bowel disease compared to the general population, the study stated.

But it seemed, from the analysis, that the drug wasn’t to blame. The authors said environmental risk factors, such as smoking, infections and high doses of NSAIDs medication, were more closely tied to IBD.

Of course, every patient was different, said Associate Professor Bird, a rheumatologist affiliated with UNSW.

Rheumatologists would obviously take patients off cosentyx (secukinumab) if it seemed to cause gastrointestinal problems, he said.

“Of course, for any treatment we give patients, we don’t want sub-clinical bowel disease flaring as well,” he said. After all, what could be worse than adding gastrointestinal discomfort to a patient already experiencing chronic pain?

There are many different classes of biologic drugs to treat psoriatic diseases, with secukinumab being one option.

Some other options are humira and remicade, which are not associated with IBD, said Associate Professor Bird.

But, while this study offered some reassurance, there was no guarantee patients wouldn’t develop inflammatory bowel disease when prescribed cosentyx (secukinumab), he said.

“It’s a low number [in the study] but they are still there. I’m still going to have some concerns inflammatory bowel disease is still happening,” he said.

Associate Professor Bird said further studies were needed to establish whether the drug was causing IBD in patients.